ASK THE EXPERTS

MARY ANDRIOLA, MD.

Professor of Neurology Director of Child Neurology, Clinical Neurophysiology, and the Long Island Comprehensive Epilepsy Center

Epilepsy and seizures affect more than three million Americans, with about 200,000 new cases diagnosed each year. Properly diagnosed and treated, most people with epilepsy can expect to get their seizures under control. Patients who have persistent, recurrent seizures or those with an unconfirmed seizure diagnosis may benefit from the advanced services of a comprehensive epilepsy center.

What is the difference between a seizure and epilepsy? Seizures happen when your nerve cells fire more rapidly and with less control than usual, affecting how a person feels or acts. These range from "absence seizures" involving a brief lapse of conscious activity to "complex, partial seizures" where one is unaware and unresponsive, to seizures where there is a full loss of consciousness with the potential for falling, shaking, and difficulty breathing. Epilepsy refers to a brain disorder resulting in multiple seizures.

Does having a seizure mean you have epilepsy?Seizures are not always related to epilepsy. They can be a symptom of a disruption of brain function, such as from a high fever, a head injury, or lack of oxygen. Ten percent of Americans experience a seizure at least once in their lifetimes, with the highest incidence occurring under the age of two and over the age of 65.

What causes epilepsy?Epilepsy may be related to genetic factors, structural abnormalities of the brain or brain metabolism, and can begin in infancy and childhood. It can also be acquired (become symptomatic) during the course of one's life due to infection of the brain, trauma, tumors, or stroke. When no cause is found, the term "idiopathic" is used, which may mean one has to look harder for a proper diagnosis.

How is epilepsy diagnosed?Epilepsy may be diagnosed through a detailed medical history and electroencephalogram (EEG) video monitoring to record brain wave patterns during and between seizures. Imaging scans (i.e .. MRI) of the brain and blood tests are performed to help rule out other potential causes of seizures, such as a brain tumor or other disease.

How is epilepsy treated?For a majority of patients, antiepilepsy drugs are helpful, with the goal of controlling the seizures while minimizing medication side effects. There are three new antiepileptic drugs available with different mechanisms of action: Potiga ™ (ezogabine), Fycompa ™ (perampanel) and Aptiom ™ (eslicarbazepine). For some patients, surgery may be an option. In particular, epilepsy surgery may benefit patients whose seizures are associated with structural brain abnormalities, such as brain tumors, malformations of blood vessels and damage related to strokes. Vagus nerve stimulation, designed to send mild electrical pulses to the brain by a device that is like a pacemaker, is a surgical option for some patients.

Diet can also be a treatment for some, specifically the ketogenic diet or a modified Atkins diet. The diets are prescribed by a physician and carefully monitored by a dietitian.

What is the success rate for controlling epilepsy?Properly diagnosed and treated, most people with epilepsy do very well. Nationally, two out of three people with epilepsy can be expected to enter remission; that is, five or more years free of seizures while using medication. About 75 percent of people who are seizure free while on medication for two to five years can be successfully withdrawn from medication.

What distinguishes Stony Brook's approach?A multidisciplinary team of specialists makes a difference. Seizures and epilepsy can involve and affect multiple body systems, so having a staff with broadbased expertise readily available helps achieve a more effective treatment plan.

In addition to a multidisciplinary team that includes renowned epileptologists, pediatric neurologists, and neurosurgeons, our Comprehensive Epilepsy Center offers unique capabilities:

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